BACKGROUND Rectal sparing is an option for some rectal cancers with complete or good response after chemoradiotherapy(CRT);however,it has never been evaluated in patients with metastases.We assessed long-term outcomes...BACKGROUND Rectal sparing is an option for some rectal cancers with complete or good response after chemoradiotherapy(CRT);however,it has never been evaluated in patients with metastases.We assessed long-term outcomes of a rectal-sparing approach in a liver-first strategy for patients with rectal cancer with resectable liver metastases.CASE SUMMARY We examined patients who underwent an organ-sparing approach for rectal cancer with synchronous liver metastases using a liver-first strategy during 2010-2015(n=8).Patients received primary chemotherapy and pelvic CRT.Liver surgery was performed during the interval between CRT completion and rectal tumor re-evaluation.Clinical and oncological characteristics and long-term outcomes were assessed.CASE SUMMARY All patients underwent liver metastatic resection with curative intent.The R0 rate was 100%.Six and two patients underwent local excision and a watch-and-wait(WW)approach,respectively.All patients had T3N1 tumors at diagnosis and had good clinical response after CRT.The median survival time was 60(range,14-127)mo.Three patients were disease free for 5,8,and 10 years after the procedure.Five patients developed metastatic recurrence in the liver(n=5)and/or lungs(n=2).Only one patient developed local recurrence concurrent with metastatic recurrence 24 mo after the WW approach.Two patients died during follow-up.CONCLUSION The results suggest good local control in patients undergoing organ-sparing strategies for rectal cancer with synchronous liver metastasis.Prospective trials are required to validate these data and identify good candidates for these strategies.展开更多
文摘BACKGROUND Rectal sparing is an option for some rectal cancers with complete or good response after chemoradiotherapy(CRT);however,it has never been evaluated in patients with metastases.We assessed long-term outcomes of a rectal-sparing approach in a liver-first strategy for patients with rectal cancer with resectable liver metastases.CASE SUMMARY We examined patients who underwent an organ-sparing approach for rectal cancer with synchronous liver metastases using a liver-first strategy during 2010-2015(n=8).Patients received primary chemotherapy and pelvic CRT.Liver surgery was performed during the interval between CRT completion and rectal tumor re-evaluation.Clinical and oncological characteristics and long-term outcomes were assessed.CASE SUMMARY All patients underwent liver metastatic resection with curative intent.The R0 rate was 100%.Six and two patients underwent local excision and a watch-and-wait(WW)approach,respectively.All patients had T3N1 tumors at diagnosis and had good clinical response after CRT.The median survival time was 60(range,14-127)mo.Three patients were disease free for 5,8,and 10 years after the procedure.Five patients developed metastatic recurrence in the liver(n=5)and/or lungs(n=2).Only one patient developed local recurrence concurrent with metastatic recurrence 24 mo after the WW approach.Two patients died during follow-up.CONCLUSION The results suggest good local control in patients undergoing organ-sparing strategies for rectal cancer with synchronous liver metastasis.Prospective trials are required to validate these data and identify good candidates for these strategies.
